The objective of this project is to determine to what extent facility structure and care process are related to outcomes in patients with hip fracture admitted to skilled nursing facilities (SNFs). To hundred fifteen patients admitted to fourteen SNFs in Durham, Orange, Wake and Guilford Counties of North Carolina are being followed-up eight months post-fracture in a retrospective cohort design. One set of hypotheses will examine to what extent the belief that physical therapy services (structure) available are important in recovery from hip fracture, influences admissions to the facilities. A second set of hypotheses examine the relationship between structure and process and outcome, after controlling for potential confounders in the statistical analysis. The contributions of physician, nursing and physical therapy structure to outcome will be measured. Structural scores for these services will be derived primarily from Medicare/Medicaid SNF Survey Report forms, supplemented by facility data giving nursing and physical therapy hours per patient per day available. The relationships between nursing and physical therapy process of care and outcome will be estimated using established explicit criteria to measure process. These criteria are being developed using the Delphi group opinion technique to obtain the opinions of a group of nurses and physical therapists on what potential care items are essential in the care of patients with hip fracture. It will be determined if variations in structure and process are most critical for patients who are initially at a higher risk of not recovering from the injury.